Treatment decision6 min read
What criteria the surgical decision rests on in scoliosis
The prospect of surgery is the greatest concern for people diagnosed with scoliosis. Surgery arises in a small proportion of cases, and the decision rests not on a single number but on several criteria assessed together.
When conservative follow-up continues
For curves under forty degrees in people whose growth is complete, the conservative approach continues. Progression in this group is markedly slow.
Where pain is controlled by an exercise programme and daily function is preserved, surgery does not arise. What is decisive is the limitation experienced, not the angle on the image.
Where respiratory function is within normal limits, follow-up is also preferred. Reduced respiratory capacity is an important component of the surgical decision.
When surgery comes into consideration
Curves above forty-five to fifty degrees fall within surgical assessment. Curves at this level can continue to progress slowly even after growth is complete.
Curves progressing more than five degrees in six months during growth are placed under close monitoring and assessed for surgery, even at a lower absolute angle.
Where the curve restricts respiratory function, produces pain unresponsive to conservative treatment, or markedly disturbs trunk balance, surgery is offered as an option.
Physiotherapy after surgery
Post-surgical rehabilitation is decisive for the durability of the result. In the early period, breathing exercises, safe movement education and a walking programme are applied.
Fused segments do not move, so mobility in neighbouring regions and endurance of the trunk muscles become especially important. The programme targets both.
Return to sport and heavy work is planned progressively and run in line with the surgeon's timetable. Early loading can adversely affect fusion healing.
Key points
- Surgery arises in a small proportion of scoliosis cases.
- The decision rests on progression rate and function, not the angle alone.
- Curves above forty-five to fifty degrees fall within surgical assessment.
- Progression over five degrees in six months during growth requires close monitoring.
- Post-surgical rehabilitation directly affects how durable the result is.
Frequently asked questions
Will the curve keep increasing without surgery?
No. In curves under forty degrees with completed growth, progression is very slow. The risk of progression is mainly high during growth and at greater angles.
Is movement restricted after surgery?
Movement is permanently reduced at fused segments. Most daily activities are preserved, however, and the degree of restriction depends on how many levels are fused.
Does physiotherapy prevent surgery?
It cannot guarantee it. Exercise and bracing are shown to slow progression during growth, which in some people can prevent the surgical threshold being reached. The outcome depends on the initial curve and remaining growth potential.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.